Membership Type
Would you like to join the Service User or Carer or Public membership? (Service Users must have used NSFT services within the last three years; Carers must currently be the carer of an NSFT service user; Service Users or Carers can be Public members if pr
Member type	Public Service User or Carer
Title	Unspecified Mr Mrs Miss Ms Dr Professor Canon Reverend Wing Commander Capt Col Major Commodore Cllr Sister Master Lady Mayor Father Honourable Lord Lt Col Senior Counsel Sir Commander
First name *
Last name *
Date of birth *	DD MM YYYY
Gender	Unspecified Male Female Transgender Male Transgender Female Other
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Address *
Town or City
County
Postcode *
Country
Telephone
Mobile
Email
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Preferred method of contact	Email Post
Ethnic Origin	Not stated White - English, Welsh, Scottish, Northern Irish, British White - Irish White - Gypsy or Irish Traveller White - Other Mixed - White and Black Caribbean Mixed - White and Black African Mixed - White and Asian Mixed - Other Mixed Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - Bangladeshi Asian or Asian British - Chinese Asian or Asian British - Other Asian Black or Black British - African Black or Black British - Caribbean Black or Black British - Other Black Other Ethnic Group - Arab Other Ethnic Group - Any Other Ethnic Group
Religion/Belief	Not Stated Christian Muslim Hindu Jewish Atheist Other Prefer not to say
Sexual Orientation	Not Stated Heterosexual Gay or Lesbian Prefer not to say Bisexual Other

Disabilities	No Yes A sensory disability A physical disability A learning disability A mental health problem Any other special need (please list in the 'Notes' section) Hearing impairment Any other special need Visual impairment Autism Prefer not to say
How would you like to be involved?	Interested in finding out more about standing as a governor Volunteer at the Trust

Member type
Last Used Services
Title
First name
Last name
Date of birth
Gender
Address
County
Postcode
Country	UK
Telephone
Mobile
Email
Ethnic Origin
Religion/Belief
Sexual Orientation
Preferred method of contact
Disabilities
How would you like to be involved?

*  I apply to be a member of Norfolk and Suffolk NHS Foundation Trust and be bound by the rules of the organisation. I give consent to the processing of my information.

The data you supply will be used only to contact you about the Trust, membership or other related issues. In accordance with the General Data Protection Regulations (GDPR): Information will be kept secure, treated confidentially and only used for developing the Foundation Trust. Our main trust wide privacy notice, which sets out in full the Trust's lawful reasons for processing personal data and all your rights under GDPR is available to view and download at www.nsft.nhs.uk.

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Please tick here if you consent to your details being added to the Public Register.